Since the September 11, 2001 attacks on the World Trade Center, there has been growing concern about illness and injuries among the estimated 40,000 who worked or volunteered on the WTC rescue and recovery effort. WTC responders sustained exposures to a range of environmental toxins, psychological trauma and physical hazards. Many responders developed health effects from these exposures; whether long term health effects will persist or develop into chronic conditions is unknown. This proposal requests funding to establish a Clinical Center based in the existing Mount Sinai Clinical Program of the World Trade Center Worker and Volunteer Medical Screening Program (MSP). The Mount Sinai Clinical Center (MSCC) will provide periodic medical screening examinations for an estimated 8500 WTC responders who will have received baseline examinations at the Mount Sinai MSP as of March 31, 2004 and will provide baseline and follow up examinations for an additional 500 WTC responders over a 5 year period thus providing approximately a total of 27,000 medical screening exams for 9000 WTC responders at 1 [unreadable] year intervals. The MSCC will evaluate each responder for new or persistent WTC-related physical and/or mental health 3roblems and inform each responder about his or her examination results The MSCC will assist affected esponders with obtaining follow-up diagnostic testing and/or treatment for health problems identified in the screening exams, and in accessing available benefits. The MSCC will provide ongoing outreach to, and tracking of contact information for all 9000 WTC responders who we anticipate will request ongoing periodic examinations at Mount Sinai for the 5 year period of the proposed project. Standardized data will be sent to the Data and Coordinating Center (DCC), and the MSCC will participate in Quality Assurance programs as designed by the DCC. The Mount Sinai Center was the only MSP clinical site providing multilingual capacity; the MSCC will continue to provide clinical evaluations in the participant's language of choice.